Ruth Armstrong: Behind the stats

MY first patient on my first day in general practice was a man with impacted wax in his ear canal. He’d been using drops for a few days and was now almost completely deaf.

A couple of gentle squirts from an ear syringe later he danced out of the consulting room thanking me profusely.

I had found my place in medicine!

Measuring success in health care based on grateful patients is somewhat simplistic. On the other hand, the “patient experience” test can be a galvanising drive to quality.

Heading up MJA InSight this week is a good news story about an enhanced mode of acute cardiac care delivery that has all but closed the gap in mortality from myocardial infarction between rural and urban-living South Australians.

The study’s findings are impressive but a quote from one rural doctor brings to life what the service might mean for the individual patient experience.

“Let’s put ourselves in the patient’s position. If I’ve got a blocked artery, yes it would be good to have immediate care at my local hospital, but if there is a streamlined pathway to super treatment in a tertiary hospital, it’s advantageous to the patient.”

One of Australia’s best-publicised cases of a grateful patient occurred in 1991, when media tycoon Kerry Packer was brought back from the brink because the ambulance dispatched to the polo match where he had his cardiac arrest happened to be equipped with a defibrillator.

After his recovery Packer donated $2.5 million to the NSW ambulance service to make sure all its ambulances were similarly outfitted.

As Jane McCredie found out this week — more than 2 decades after Packer’s unexpected gift — grateful patients have become an industry in the US, where doctors are encouraged to court potential philanthropists in the course of clinical care.

Gratitude is good if you can get it, but much of the work that goes into sustaining a high-quality medical system remains invisible to patients.

It is unlikely that many people will be lining up to thank the Medical Board of Australia, for instance, for its work in developing a system to ensure that all registered medical practitioners are fit to provide safe care.

An MJA article has reignited debate about whether this should be achieved through regular revalidation, the subject of another of our InSight news stories.

Equally unlikely to take home a bouquet from an individual patient for his tireless efforts to protect the public from quackery, is ex-La Trobe University professor of public health Ken Harvey. Harvey’s resignation from his academic appointment, after revelations that the university had signed an agreement with the Swisse Wellness company to establish a complementary medicines research centre, has caused quite a stir. In the first of two invited comments this week, Professor John Dwyer, president of the Friends of Science in Medicine, explains why the Swisse deal should be abandoned.

On National Close the Gap Day last Wednesday, Prime Minister Tony Abbott noted, at the launch of his Closing the Gap report, poor progress towards the goal of closing the life expectancy gap between Indigenous and non-Indigenous Australians.

Among the responses to the report, one short article from the Close the Gap steering committee co-chairs, Mick Gooda and Kirstie Parker, provided a glimpse of the patient experience that accompanies the harsh statistics. With the article they republished, with family permission, a photograph of Clarence Paul, from Mornington Island, and his grandson. It became “an iconic campaign photo” for Close the Gap in 2007, but he died just 2 years later at age 48, “… a much loved uncle, father, grandfather, brother, son and respected community member”.

The image and the story stand alongside the statistics to remind us why health equality is worth striving for: there is much to be done but also much to be gained in years of life, wellness and productivity, and families sustained. And we may pick up a few grateful patients along the way.

Lots of interesting topics – I’ll start with one: private philanthropy, as practised commonly in the US, suits the preference of some parts of the American community for hands-off government. It goes with self-insurance, a wide gap between rich and poor, and the huge underclass with little access to health care. The problem I see with private philanthropy is that it is aimed at the donor’s interests, not the objective needs of the community. In Australia, we pay taxes, fund health care, and vote for representatives that negotiate over the funding split. We can then decide in some sort of collective process whether the health dollar is better spent on cardiac arrests, diabetes educators, early chidhood nurses or NICU beds, or what proportion on each.